Toilet Training and Toilet Problems
Toilet training can be a worry for many parents - the very words can ring alarm bells, and toileting can a cause of anxiety for children too. This blog post - drawn from my experience a clinical child psychologist and as a parent who has done this once before and will be doing this again in the next year or so - gives some simple ideas and techniques to help you manage toilet-training, and deal with any problems which may arise later on. When Should I Begin Toilet Training My Child?
There is a wide variation in the age that children become toilet- trained, even in the same family. Despite anxious relatives, neighbours and anyone else who thinks they know better, children become toilet trained only when they are ready. Toilet-training will be impossible before the child's nerve pathways are properly developed. This is usually around 18 months (at the earliest) to 3 years. For toilet-training to be successful, make sure you start when you can devote lots of time and attention for rush trips to the potty or toilet. Also, choose a time when you are not experiencing or expecting any big changes in your child's life (e.g. birth of a brother or sister).
Toilet-training will only really work when your child:
- is able to sit for at least 5 minutes; maybe whilst looking at a book or playing with a toy
- able to let you know (by telling you verbally or non-verbally) when s/he has done a wee or poo
- able to follow simple instructions (e.g. to sit down on the potty)
- keen to help dress and undress him/herself
You may hear older generations boast that in their day children were trained at around 1-year-old. However, that was more likely to be a result of ‘toilet timing’ rather than ‘toilet training’. That is, the adult times the toilet visit around when they thought the child would need to go. When you think of cold water, poor detergents, non-disposable nappies and hand-washing of days gone by, it is easy to see why toilet-timing / training became and necessary obsession.
How Should I Start Toilet Training?
In the weeks before you start toilet-training, take your child with you to the toilet or leave the bathroom door open, and explain what you are doing. But you may also be one of the many parents who find it difficult to keep their child out of the bathroom when they’re trying to use it - in which case, you’ve probably already done this. This helps children to start to make the link between feeling their body urinating and seeing the urine.
Many parents choose to start toilet-training with a potty, because it is portable in and out-of-doors for use without much notice. Praise any interest your child shows in the potty or toilet. Remember to take spare pants and clothes on outings, in case of accidents.
Many children use toilet-training to show that they are in charge or control, and refuse to sit on the potty or toilet. It is a waste of time to force the child to sit there as they will not be relaxed enough to go, or will associate toileting with tension and wet themselves whenever they feel tense. Ignore any rebellion, and if necessary stop all attempts to toilet-train. Try not to get into a battle over it. Once all is calm, gradually try again with small attempts at sitting.
Many children gain control over their bowels before their bladder. Frequency of bowel movements can vary considerably, depending on the age of the child.
- Try and sit your child on a potty or toilet a few times a day for 5 to 10 minutes, ideally after meals and when you know your child often has a poo. Make it fun with books and toys, to get you child used to the idea of sitting and aiming.
- One the skill of sitting is established, give gentle praise and encouragement. Give lots of praise and rewards if your child successfully poos. If nothing happens, don’t make a fuss - simply ignore it and try again later.
Sometimes a child may develop specific habits around toileting (e.g. only in a certain place in the room - in the potty, that is). If it doesn’t make any difference to the situation, it's probably not worth making a fuss over. Gradually, you’ll find a way to be able to negotiate another way around it. Pick your battles in the establishment phase.
Daytime Bladder Training
Children should be encouraged to sit on the potty or toilet; boys don't normally start to stand up to wee until they are aged 3 years or above.
- You may want to prepare your flooring, and dress your child in normal pants to help them to learn the difference between wet and dry. Some nappies are so effective at absorbing urine, that they do not allow the child to feel wet. Alternatively, allowing your child to play outside with few clothes if is the summer (and if this is an option for you) will help them to realise when they are wet. Pants are also easier for children to pull up and down.
- Sit your child regularly after mealtimes or drink times. Initially you may just praise small steps, such as sitting down for a few seconds. If there is success on the potty or toilet, give lots of praise and rewards, even if it was a fluke. Then your child will realise that s/ he has done something good and will try again next time.
What About Bed-Wetting?
The best time to withdraw the night-time nappy is when there have been several consistently dry nights in a row - this may be a long time after your child is dry in the day. In fact, bed-wetting occurs in about 10-20% of all 5 year olds.
Do not cut out daytime fluid intake, as your child will need a full bladder to distinguish "knowing" when they need a wee. Also, cutting out drinks can be harmful - you might just try cutting out just the last drink before bed. Many parents wake their children up to use the toilet before they themselves go to bed last thing at night.
The same rule applies - praise your child when they have a dry night and do not make a big deal when they are wet. From 3 years old children generally enjoy earning stickers for dry nights on a wallchart.
What Happens if My Child Starts to Wet or Soil, After Being Clean for a While?
Wetting and soiling are common occurrences in young children. Research shows that one out of ten 5 year olds wet themselves in the day. It is important that you do not tell your child off for accidents. Be patient and encouraging towards your child, and remind him/her to regularly to use the potty or toilet. Don 't go back to using nappies.
If the Problem is Persistent:
- Check with your GP that there is not a medical problem, like constipation. Constipation can be detected if your child is in pain, has bad breath, no energy etc. Fruit, vegetables and drinking plenty of water should help to prevent constipation. Constipation is a common cause of soiling, as the bowel becomes blocked with hard faeces and then it becomes painful to pass them. Liquid fasces then leak around the blockage. A doctor will need to be involved to help to solve this problem.
- Other medical problems include diarrhoea, which is common in toddlers when they get illnesses or for no obvious reason at all. It is usually temporary and short-lived. Urinary problems are usually detectable by a "fishy" smell, pain passing water, or excessive thirst.
- Think about whether there has been any big changes or tensions in your child's life (e.g. starting daycare). Wetting, soiling and smearing may be a result of more difficult tensions, and upset. This needs to be explored with the child by talking at a suitable, relaxed time; you may feel a health professional could help with this.
- You can buy waterproof mattress protectors for long-term bedwetting problems, and from 7 years old children can be helped by night-time alarms.
- If your child seems to be afraid of the toilet, try using a trainer seat and foot support, making the bathroom a fun place with toys, books and posters, making sure it is warm, and role playing with dolls and teddies
- It will always help to establish a regular routine for using the toilet, and encouraging the child to gradually "take over" the routine with less supervision from an adult. They could earn points or stickers for parts of the routine they are beginning to master, such as going to the toilet without being told, staying on the toilet, telling someone they have soiled, dealing with dirty underwear, etc.
If your child has a learning difficulty or developmental delay, it may take them longer to acquire both the biological mechanisms and day-to-day understanding of using the toilet. It may just take longer, and you may start toilet training later, but the rules and tips outlined in this leaflet still apply.
You may need to use pictures of the toilet to help children who have significant communication difficulties. You could find out more by talking to your child's speech and language therapist.
Basic Rules to Remember:
You can’t go far wrong with toilet training so long as you:
- Start when you child is ready
- Don’t force your child to sue the potty or toilet
- Take your time in toilet training. It will happen.
- Remember that every child and family has their own unique way and pace of doing things.
- Keep positive - give your child lots of praise for successes; and don’t blame your child for accidents.